PROJECT SUMMARY/ABSTRACT Dr. Christine Call, PI of the proposed K23, is a clinical psychologist with a long-term career goal of leading a program of research focused on promoting health equity during high-risk times for problematic eating, excess weight gain, and obesity, such as pregnancy and postpartum (i.e., the perinatal period). To facilitate this goal, Dr. Call’s training aims are to: (1) Develop expertise in the conceptualization and longitudinal assessment of psychosocial and behavioral factors influencing perinatal weight, including perinatal eating, appetite, mood, and social determinants of health (SDoH); (2) Gain hands-on experience conducting community-partnered health equity research; and (3) Attain skills to conduct and analyze ecological momentary assessment (EMA) studies and model longitudinal data. Training will be guided by expert mentors, including primary mentor Dr. Michele Levine, an expert in perinatal obesity, and co-mentor Dr. Sarah Pedersen, an expert in community- engaged health equity research and EMA. The proposed training will enable Dr. Call to conduct an innovative study to identify psychosocial and behavioral pathways through which food insecurity predicts higher gestational weight gain (GWG) and postpartum weight retention (PPWR). Food insecurity is a multidimensional construct encompassing disruptions in access to food quantity and quality, psychological wellbeing, and social acceptability related to food acquisition. Although food insecurity predicts excess GWG/PPWR, pathways underlying the relation of food insecurity to GWG/PPWR are poorly understood. Appetitive drives, psychosocial distress, and disinhibited eating are associated with food insecurity in non-pregnant populations. Accordingly, using community-engaged methods, Dr. Call will enroll pregnant people at risk for food insecurity (N=100; >50% with racial or ethnic minoritized identities) in early pregnancy and assess relationships among food insecurity, appetitive drives, psychosocial distress, disinhibited eating, and weight in each trimester of pregnancy and at 3-months postpartum. A subset of participants (N=50) will complete a 10-day EMA at each timepoint to identify momentary relationships. SDoH that co-occur with food insecurity, such as discrimination, will be assessed. In Aim 1, prospective relationships among food insecurity, appetitive drives, psychosocial distress, disinhibited eating, and weight will be examined across pregnancy and 3-months postpartum. In Aim 2, these relationships will be tested at a daily level using EMA. Exploratory Aim 3 will examine (a) if the dimensions of food insecurity (quantity, quality, psychological acceptability, social acceptability) differentially predict outcomes, and (b) if relationships between food insecurity and outcomes differ by other SDoH related to perinatal weight. Findings will provide critical data on the relationship of food insecurity to GWG/PPWR and inform future structural and individual level interventions to improve weight outcomes among pregnant individuals with food insecurity. These aims align with NIDDK’s mission and scientific priorities and will support a sustainable line of research designed to promote perinatal health equity and decrease obesity risk.

PROJECT NARRATIVE Food insecurity in pregnancy predicts excess gestational weight gain and postpartum weight retention, is associated with intergenerational obesity risk, and disproportionately affects pregnant individuals with minoritized identities. To develop interventions that target obesity risk in pregnant and postpartum individuals with food insecurity, it is first necessary to identify the behavioral and psychosocial pathways through which food insecurity contributes to weight change during these periods. Through a community-engaged research lens that prioritizes ongoing collaboration with community members, this study will test momentary and longitudinal relationships among food insecurity, appetitive drives, psychosocial distress, disinhibited eating, and weight change in pregnancy and postpartum, thus informing treatment targets for future multi-level intervention development work and promoting intergenerational health equity.